HEALTH CARE BRIEFING: U.S. Eyes Medicare Coverage of Covid Tests

Medicare beneficiaries who purchase at-home Covid-19 tests may soon be able to seek reimbursement like those with private insurance currently can.

“Yes on Medicare,” White House Covid-19 coordinator Jeff Zients said yesterday during a press briefing when asked if there’s an effort to have Medicare cover rapid tests. The Centers for Medicare and Medicaid Services is “exploring the best way to provide more testing options to Medicare beneficiaries,” he said.

The Medicare agency confirmed in a statement to Bloomberg Law that it “is exploring ways that Medicare can cover them as we look to overcome a number of statutory and regulatory hurdles.” The agency currently pays for lab-run tests, such as PCR tests, but not over-the-counter tests. “We recognize testing remains a critical tool to help mitigate the spread of COVID-19, and we are committed to providing resources to keep Medicare beneficiaries safe and healthy,” the CMS said.

The Biden administration earlier this month mandated that private insurance companies cover the cost of at-home tests. Under the policy, a family of four on the same plan could get up to 32 covered tests per month. There’s no limit on the number of tests that are covered if ordered or administered by a health-care provider following an individualized clinical assessment.

The change was part of a winter strategy announced in December, about a week after the identification of the highly contagious omicron variant. Democrats in both chambers have called for extending that same coverage to Medicare beneficiaries.

Without a comparable Medicare benefit, over 18% of Americans will have to pay out of pocket for additional home Covid-19 tests, House Energy and Commerce Health Subcommittee Chair Anna Eshoo (D-Calif.) wrote in a letter to Health and Human Services Secretary Xavier Becerra. “I am disappointed that the reimbursement option for eight additional at-home tests per month per person only applies to those with private or group health insurance,” said Eshoo.

About 20 senators wrote a similar letter to Becerra on Jan. 24 in an effort led by Sen. Debbie Stabenow (D-Mich.), chairwoman of the Senate Finance Committee’s health panel. “The current policy leaves them on the hook for potentially significant out-of-pocket costs,” the senators wrote. Read more from Jeannie Baumann.

Also on Lawmakers’ Radars

Breyer, Proponent of Abortion Rights, to Depart: Supreme Court Justice Stephen Breyer is planning to retire, giving Biden a chance to fill the vacancy as a confirmation battle brews in the Senate. The news comes midway in a Supreme Court term that could see the conservative-majority court overturn Roe v. Wade, although he could make his retirement effective at the end of the court’s current term, which is scheduled to run through late June.

As a justice, Breyer voted to strengthen abortion rights. He crafted the two biggest abortion-rights rulings of his tenure: a 2000 decision that struck down Nebraska’s ban on a procedure opponents called “partial-birth” abortion; and a 2016 ruling that would have closed three-quarters of the state’s clinics by imposing new rules on clinics and doctors. The court’s conservatives later chipped away at both of those rulings. Read more from Greg Stohr and Jennifer Epstein.

  • Senate Majority Leader Chuck Schumer wants to confirm Biden’s choice to replace Breyer on an expedited timeline that would take only weeks to finish. Schumer (D-N.Y.) plans to move Biden’s nominee through the process on a timetable similar to that used by Republicans to confirm Justice Amy Coney Barrett in 2020, according to a person familiar with his plans. She was confirmed 30 days after then-President Donald Trump made the nomination. Read more from Laura Litvan and Steven T. Dennis.

Sanders Join Calls for Lower Medicare Premiums: Sen. Bernie Sanders (I-Vt.) is joining a chorus of calls by Democrats to reduce monthly premiums for Medicare beneficiaries this year. The Biden administration “should immediately lower Medicare premiums by at least $11.50 a month and provide a refund to some 57 million senior citizens for the premium increases that have already gone into effect this month,” he said. Read his letter here.

Letters & Lawmakers:

The Coronavirus Pandemic

Paid Leave Falls Apart as Covid-19 Keeps the Ill at Home: The omicron surge highlighted with new urgency that when Americans get sick, most don’t get paid time off from work. At the start of this month, 8.8 million people reported that they weren’t working because they had Covid-19 or were caring for someone who did, according to the Household Pulse Survey from the Census Bureau. That’s nearly triple the figure from December. For many, that could mean forgoing a paycheck or going to work while infectious. Read more from Kelsey Butler.

  • Meanwhile, as companies yet again call workers back into the office, employees are losing faith that their managers can get it right this time after so many fits and starts. The share of virtual workers who trust their companies to make the right call on returning to the office hit its lowest point in 12 months, according to a survey by pollster Morning Consult. Just over half agreed, down from about two-thirds who expressed trust in their firms in recent months. Matthew Boyle has more.

Homeland’s Virus Protocols Lacking, Whistleblowers Say: The Homeland Security Department is using substandard Covid-19 protocols in immigration detention facilities, whistleblowers wrote. Physicians Scott Allen and Josiah Rich, subject-matter experts for DHS’s civil rights office, raised alarms about inconsistent testing and enforcement of mask requirements, a failure to develop facility-specific plans to control transmission, and a failure to broadly distribute booster doses, Ellen M. Gilmer reports.

Dying Covid-19 Liability Shield Laws Prompt Push for Their Revival: Business groups are urging extension of Covid-19 liability shield laws as the measures enacted near the outset of the pandemic in places such as Ohio, Georgia, and Tennessee expire and the political pressure to retain them wanes. Thirty states enacted Covid-19 liability shields in 2020 and 2021 that broadly immunized businesses and other entities from lawsuits blaming them for a person’s coronavirus exposure, injury, or death. As proponents try to get them extended, generally in states with GOP-majority legislatures, they face waning interest in legislative responses to the pandemic. Read more from Chris Marr.

Study Says U.S., Other ‘Populist’ Nations Mishandled Pandemic: The U.S., Britain, Brazil and other nations with “populist” governments mishandled the Covid-19 pandemic in 2020 and caused unnecessary deaths with relatively lenient policies, according to an academic research paper. Excess mortality — the number of deaths beyond those that could be expected without the pandemic — was more than twice as high on average in populist-governed countries, Michael Bayerlein, a researcher at the Kiel Institute for the World Economy and one of the authors of the paper, said in a press release today. Read more from Iain Rogers.

More Headlines:

What Else to Know

Generic Makers Get Tips on Speeding FDA Product Reviews: Drugmakers should include consistent labeling information and detailed data on active ingredients in generic drug applications to avoid slowing down the FDA review process, the FDA said in a release. The goal of the documents is to boost efficiency and limit the number of review cycles needed to bring a new low-cost drug to market. Read more from Celine Castronuovo.

Medicare’s Coordinated Care Effort Sees Modest Growth: Groups of doctors, hospitals, and clinicians that provide coordinated care through traditional Medicare will serve over 11 million beneficiaries in 2022, up 324,000—or 3%—from last year, according to the White House. These accountable care organizations form part of the Medicare Shared Savings Program—Medicare’s national ACO program and the leading value-based care initiative of CMS. Read more from Tony Pugh.

More Headlines:

With assistance from Ellen M. Gilmer

To contact the reporter on this story: Brandon Lee in Washington at blee@bgov.com

To contact the editors responsible for this story: Zachary Sherwood at zsherwood@bgov.com; Giuseppe Macri at gmacri@bgov.com; Michaela Ross at mross@bgov.com

Top